From the March 2019 issue of HealthCare Business News magazine
How about the radiology resident who is addressing the mother’s concerns? Here is the second instance of fear and uncertainty in the vignette. I think discussing radiation risk is among the more challenging aspects of my job. This is, in part, due to a lack of experience and formal training most radiology residencies provide. But I think this is primarily because available data regarding carcinogenic risk at low radiation levels, i.e., those encountered in medical imaging, are relatively sparse and variable. Most of the older data pertaining to radiation causing cancer were extrapolated from Japanese atomic bomb survivors. A handful of larger epidemiologic studies have been published this decade attempting to more precisely quantify the risk of cancer children encounter when obtaining CT scans. While each of these studies has limitations, all of them concluded that the risk of a child getting cancer from one CT scan is low, typically much less than one percent. Many organizations, such as the National Academy of Sciences, the American Association of Physicists in Medicine, and the United Nations have published statements clarifying that risk of cancer from medical imaging is unclear and may be negligible at such low doses. To further muddy the waters, we must also consider annual background radiation, much of which is derived from naturally occurring radon gas found in homes. A child may receive the equivalent dose of at least one CT scan in background radiation each year by merely watching TV, going to school, visiting friends, etc.
Patients today are more educated than ever before. The information available to them, and their desire to be proactive in their care, are both far cries from the heyday of paternalistic medicine in the 20th century. The parents of children in our practice are often well-educated professionals who are familiar with the concept of radiation in medical imaging, have informed questions, and look to us for additional, nuanced information to help them make the right decisions. They often want the radiologist to give them a sense of what the data shows regarding the radiation risk from imaging. It is the responsibility of the radiologist to be an informed consultant who can communicate the risks effectively, is sensitive to the concerns of the family regarding radiation, and partners with the family to decide on the best imaging pathway.
Accurately conveying these risks in both absolute and relative terms, in a way that the patients can understand and appreciate, is the “holy grail” for the radiologist in this setting. There is no correct way to do this, as every person processes information differently. It is often helpful to begin with general statements to not confuse the family with minutia: “the radiation risk posed by this CT scan is very low, if truly present at all.” However, in my experience, patients are more frequently asking for numbers – more precise data to guide their decisions. For example, when consulting with the patient’s mother, the radiology resident in the vignette could incorporate the following:
